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Find a Physician Assistants Expert →Overview
A physician assistant expert decides what a reasonably careful PA would have done in the same setting: what should have been asked, examined and ordered, when a physician should have been brought in, and whether supervision worked as the state and the employer required. These cases often involve a missed diagnosis in an emergency department, urgent care or clinic. This page covers PA practice. Nurse practitioner care belongs to a nursing standards expert, attending physician duties to a physician in that specialty, and billing to a medical billing expert.
The expert reads the chart, triage notes, orders, handoff notes, the practice agreement or supervisory documents, privileging records and the employer's protocols. Time stamps show who saw the patient and when, and whether a supervising physician ever did.
Scope is set by state law and by the setting. Medicare's rule shows how much it depends on state law. It says that state law and scope of practice rules that describe the required practice relationship between physicians and physician assistants, including explicit supervisory or collaborative practice requirements, describe a form of supervision for Medicare purposes 1. To be paid under that rule, a PA must have passed the national certification examination administered by the National Commission on Certification of Physician Assistants, among other paths, and be licensed by the state to practice as a physician assistant 1.
Hospitals add another layer. Under the medical staff condition of participation, the medical staff may include non-physician practitioners determined to be eligible for appointment by the governing body, in accordance with state law including scope of practice laws 2. The medical staff must examine the credentials of all eligible candidates 2. So the privileges granted, and what the PA was actually doing, may not match. The expert compares the delegation agreement, the privileges and the practice on the day.
A study of emergency department malpractice cases from 2010 to 2019 in a national database offers useful numbers. Among 5,854 cases, 513, or 8.8 percent, involved a PA 3. Compared with cases that identified no advanced practice provider or trainee, PA cases more often involved clinical judgment at 84.6 percent, documentation at 25.9 percent and supervision at 25.7 percent 3. The comparison figure for supervision in no-extender cases was 1.8 percent 3. Cases involving PAs and nurse practitioners had a lower percentage of high-severity cases, such as loss of limb or death 3. These are claims in one database, so they show patterns and not error rates.
A central question is which standard applies. Many courts ask what a reasonably prudent PA would do, and some compare to the supervising physician's specialty. Counsel should confirm the forum's rule before retaining anyone. An expert usually addresses:
The employer's protocol matters. If a physician must review a chart within a set time, or must see certain patients, the record should show that it happened. A signature hours later is not the same as real supervision. That question can also lead to a claim against the supervising physician or the hospital, so the expert should keep the two standards apart.
Look for a licensed, certified PA with active clinical practice at the time of the events, in the same setting and specialty. NCCPA verifies board certification 4. Experience precepting students or serving on a privileging committee adds weight. State law may require a same-field expert, or may allow or demand a physician, so counsel should check early. Each opinion must stay within what a reliable method supports 5.
In a study of 5,854 emergency department malpractice cases, 513 (8.8 percent) involved a physician assistant, and supervision was a contributing factor in 25.7 percent of PA cases.
Case Types
Missed diagnosis in the emergency department
Urgent care and primary care delay
Physician supervision and availability
Scope of practice and delegation
Medication errors
Surgical assisting and first assist claims
Credentialing and privileging
Documentation and template disputes
Qualifications
Related Specialties
FAQ
Look for a licensed, certified PA in active practice at the time of the events, in the same setting and specialty. Some forums require a same-field expert, and others allow or demand a physician, so counsel should check.
State law and the setting. Medicare's rule points to state supervision and collaboration requirements, and hospitals grant privileges under their medical staff rules.
It depends on the forum. Many courts ask what a reasonably prudent PA would do, and some compare to the supervising physician's specialty. Confirm the rule first.
Not generally, but state rules and the employer's protocol decide. The expert reads the delegation terms and what actually happened.
In one national database of emergency department cases, PA cases more often involved clinical judgment, documentation and supervision than cases without an advanced practice provider or trainee.
In general, physician assistant expert fees are determined by the expert themselves, based on a variety of criteria. Among those criteria are experience, the setting, the length of the chart, supervision issues and the amount of testimony. Vident does have some influence over expert fees by comparing experts within a specialty, but ultimately it is a personal decision by the expert.
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